Things to Know About Health Insurance Today

Today begins the biggest expansion of health insurance since Medicare. According to the Congressional Budget Office (PDF), an estimated 7 million Americans will buy private health plans through the new online marketplaces known as insurance exchanges, which are now opening nationwide. That number is expected to more than triple in the years ahead.

 

It could be a bumpy launch, with technical problems and public confusion.

 

Here are 10 things you need to know about the insurance exchange program:

 

What happens today?
Starting today, you can purchase health coverage through the Affordable Care Act health insurance exchange program. The coverage kicks in Jan. 1, 2014.

 

Your coverage options depend on where you live. Some states have exchanges run by the federal government, whereas others have their own exchanges or ones created in conjunction with the Obama administration.

 

You have six months to make a choice. If by March 31 you have no health insurance, you'll face a fine of 1 percent of your yearly income or $95 per person -- whichever is higher. The fee increases every year, rising to 2.5 percent of your yearly income in 2016 or $695 per person. That's on top of any health care costs.

 

What if I have health insurance through my employer?

If you have health insurance through your employer, you can keep it.

 

Job-based plans qualify as "minimum essential coverage." In other words, you won't be fined if you're covered through your job. And because your employer pays a proportion of your premium, the coverage might be cheaper than the plans offered through the insurance exchange program.

 

You might still want to explore your options, but beware: Depending on the job-based coverage available to you, you might not qualify for certain savings offered through the health insurance exchange program.

 

What if my employer isn't offering health insurance?

You're responsible for having health insurance in 2014, whether your employer offers it or not. If your employer isn't offering health insurance, you can purchase coverage through the health insurance exchange program. You may qualify for lower premiums and out-of-pocket costs (people who have job-based coverage might not qualify for those cost-savings).

 

No employer is required to offer health insurance, but employers with more than 50 employees may be charged a fee if they fail to offer coverage that's affordable and meets a minimum standard. The fee, dubbed an Employer Shared Responsibility Payment, is up to $3,000 per employee.

 

What if I'm already covered by private health insurance?

If you have health insurance that you purchased directly from an insurance company, you don't need to buy a plan through the health insurance exchange program. But you might qualify for lower premiums and out-of-pocket costs through the exchange program, so it's worth a look.

 

Starting in 2014, all insurance plans must offer "essential health benefits" for emergency services, maternity, neonatal and pediatric care, outpatient and rehabilitation services, counseling and therapy, preventive and wellness services, and prescription drugs. This is true whether you buy the plan directly from an insurance company or through the health insurance exchange program.

 

What if I'm retired?

If you're over 65, you might be eligible for Medicare. And if you're covered through Medicare, you don't need to purchase a plan through the health insurance exchange program.

 

If you're under 65 but you have retiree health benefits, you're also considered covered. But you might qualify for lower premiums and out-of-pocket costs through the insurance exchange program, so it's worth a look.

 

If you're under 65 and you don't have retiree health benefits, you're responsible for buying insurance. If you don't have coverage in 2014, you'll face a fine. If you turn 65 in 2014 and you qualify for Medicare, you can cancel the plan you purchased.

 

What if I'm a student?

If you're under 26, you may qualify for coverage through your parents' plan. This is true even if you're married, living away from home or attending school.

 

If you turn 26 in 2014, you can enroll in a new health insurance plan even after open enrollment closes March 31.

 

If you're under 26 but not covered through you parents' plan, you can buy coverage through the health insurance exchange program starting Oct. 1. People under 30 can qualify for catastrophic coverage with a lower premium but a higher deductible.

 

What if I'm on Medicaid?

If you're covered through Medicaid, you don't need to purchase a plan through the health insurance exchange program. And under the new health care law, Medicaid eligibility is expanding in some states.

 

Visit your state's Medicaid website to find out whether you'll qualify in 2014. If you would qualify under the new income limits but your state has chosen not to expand Medicaid eligibility, you will not have to pay a fine for not purchasing health insurance.

 

What if I have a pre-existing condition?

Starting in 2014, you can't be denied health insurance or charged more because you have a pre-existing health condition, even if you've been refused coverage in the past.

 

The only exception is for grandfathered individual health insurance plans, according to HealthCare.gov. But you can purchase a new plan through the health insurance exchange program Oct. 1 and get coverage for your pre-existing conditions.

 

Can I get dental coverage?

Dental care is considered an essential health benefit for children, but not for adults.

 

Adults can choose a plan that includes dental coverage, or opt into a separate dental plan and pay an additional premium.

 

What if I don't want health insurance for religious reasons?
If you're a member of a recognized religious sect that has religious objections to health insurance, you will not have to pay a fine for not purchasing health insurance. You're also exempt from the fine if you participate in a health care sharing ministry.

 

Here are four big things to keep in mind as partisans on each side rush to render verdicts on the law’s success or failure:

• The Affordable Care Act won’t expand coverage overnight. Medicare automatically helped millions of seniors with their hospital bills a year after it was signed. The ACA is more complex, and it won’t expand coverage as quickly. The law relies on a combination of incentives for people to buy insurance, marketplaces to shop for plans, and regulations to keep those markets functioning. It may be tempting for healthy people to skip buying insurance next year: The penalty for not complying is just $95, or 1 percent of income, whichever is higher. That ratchets up significantly in the next two years, to $695 or 2.5 percent of income. Expect more people to enroll as the penalties increase.
• More states may come around. Almost half the states wanted nothing to do with Medicaid, which uses a combination of state and federal money to provide basic health coverage to poor families, when the program began in 1967, according to the Kaiser Family Foundation. Three years later, nearly every state had signed on. (Alaska joined in 1972 and Arizona did in 1982.) The Affordable Care Act is intended to expand Medicaid to encompass some low-income people who don’t currently qualify—for example, a family of four earning up to $31,322. Though about half the states are sitting on the sidelines, they may decide to expand Medicaid in the years ahead.
• Glitches are inevitable, but they’ll get sorted out. Republicans point to delays and software problems as evidence that the Affordable Care Act is not ready for prime time. There’s a precedent for this: the GOP-led expansion of Medicare drug benefits a decade ago. In the first week of the new plan, patients were turned away from pharmacy counters. Some states declared public health emergencies and President George W. Bush ordered insurers to approve patients for a month’s worth of drugs for $5 while authorities sorted out the confusion.
• The window for trying to undo the law is now closed. Opponents of Obamacare may not be ready to admit it, but the fight is over. Even with a government shutdown, the exchanges will still open. Their funding isn’t covered by the spending bills Congress halted. And, as Obamacare foe Senator Ted Cruz (R-Tex.) has said, once people begin to get insurance and subsidies through the Affordable Care Act, the law will be impossible to undo. “If we don’t do it now, in all likelihood, Obamacare will never, ever be repealed,” he told Sean Hannity.

The open question for the Affordable Care Act is whether its opponents will eventually accept it or continue to fight. Here, history may not be a guide. On the first day of Medicare, President Johnson described the program in an address to the nation. It was “a test of our willingness to work together,” he said. “In the past, we have always passed that test. I have no doubt about the future.”